Large B-cell lymphoma arising in HHV8-associated multicentric Castleman's disease

Large B-cell lymphoma arising in HHV8-associated multicentric Castleman's disease is a type of large B-cell lymphoma, recognized in the WHO 2008 classification.[1]:258–259[2]:380[3]:1113 and 1120 It is sometimes called the plasmablastic form of multicentric Castleman disease.[4][5][6] It has sometimes been confused with plasmablastic lymphoma in the literature, although that is a dissimilar specific entity.[2]:380 It has variable CD20 expression and unmutated immunoglobulin variable region genes.[2]:380[7]:513

Biology

Castleman disease (CD) is a lymphoproliferative disorder of unknown cause.[5] CD is associated with an increased risk of B-cell lymphoma.[5]

Human herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV) has been found in some cases of multicentric Castleman disease (MCD).[5][6] The HHV8 can give rise to an increased number of plasmablast cells within the mantle zone of B-cell follicles. These plasmablasts express IgM-immunoglobulin light chains, most often of lambda subtype. These plasmablasts can give rise to a spectrum of abnormalities[8] including progression to microlymphoma (microscopic clusters of plasmablast cells) or clinical lymphoma.[3]:1248–1249[5][7]:513[9][10]:1786 and 1836[11]

This type of lymphoma is predominantly seen in acquired immunodeficiencies, including acquired immunodeficiency syndrome (AIDS)[4][11] but it can also occur in immunosuppression[8] such as with organ transplantation or the elderly.[4] The plasmablasts do not show rearranged immunoglobulin genes,[2]:380[7]:513 and typically lack EBV infection.[8]

The disease predominantly affects lymph nodes and the spleen,[2]:380 a pattern dissimilar to plasmablastic lymphoma of the oral cavity of AIDS which is not associated with HHV-8 infection.[7]:513[12] Despite traditional chemotherapy with CHOP (cyclophosphamide, doxorubicin, prednisone, vincristine), and the possible addition of antiviral therapy and inhibition of specific cellular targets including the use of rituximab, the prognosis in this lymphoma has been poor.[8][13]

This lymphoma subtype has sometimes been confused with plasmablastic lymphoma in the literature, although that is a dissimilar specific entity.[2]:380 Similarly, this subtype is considered distinct from other lymphomas which have a plasmablastic immunophenotype such as primary effusion lymphoma, ALK+ large B-cell lymphoma, and extracavitary HHV–8-positive lymphoma.[2]:378–380

HHV8 is also associated with Kaposi's sarcoma and with another subtype of lymphoma, primary effusion lymphoma, previously called body cavity-based lymphoma.[4][14]

See also

References
  1. Swerdlow, Steven H. (2008). WHO classification of tumours of haematopoietic and lymphoid tissues. 2 (4th ed.). International Agency for Research on Cancer. ISBN 978-92-832-2431-0.
  2. Jaffe, ES; Harris, NL; Vardiman, JW; Campo, E; Arber, DA (2011). Hematopathology (1st ed.). Elsevier Saunders. ISBN 978-0-7216-0040-6.
  3. Hoffman, R; Benz, EJ; Silberstein, LE; Heslop, H; Weitz, J; Anastasi, J (2012). Hematology: Basic Principles and Practice (6th ed.). Elsevier. ISBN 978-1-4377-2928-3.
  4. Bhutani M, Polizzotto MN, Uldrick TS, Yarchoan R (2015). "Kaposi Sarcoma-Associated Herpesvirus-Associated Malignancies: Epidemiology, Pathogenesis, and Advances in Treatment". Semin. Oncol. 42 (2): 223–246. doi:10.1053/j.seminoncol.2014.12.027. PMC 6309362. PMID 25843728.CS1 maint: uses authors parameter (link)
  5. Dupin N, Diss TL, Kellam P, Tulliez M, Du MQ, Sicard D, Weiss RA, Isaacson PG, Boshoff C (2000). "HHV-8 is associated with a plasmablastic variant of Castleman disease that is linked to HHV-8-positive plasmablastic lymphoma". Blood. 95 (4): 1406–12. PMID 10666218.CS1 maint: uses authors parameter (link)
  6. Malnati MS, Dagna L, Ponzoni M, Lusso P (2003). "Human herpesvirus 8 (HHV-8/KSHV) and hematologic malignancies". Rev Clin Exp Hematol. 7 (4): 375–405. PMID 15129649.CS1 maint: uses authors parameter (link)
  7. Armitage, JO; Mauch PM; Harris NL; et al. (2010). "Chapter 35". Non-Hodgkin Lymphomas (2nd ed.). Lippincott Williams & Wilkins. ISBN 978-0-7817-9116-8.
  8. Carbone A, De Paoli P, Gloghini A, Vaccher E (2015). "KSHV-associated multicentric Castleman disease: A tangle of different entities requiring multitarget treatment strategies". Int. J. Cancer. 137 (2): 251–61. doi:10.1002/ijc.28923. PMID 24771491.CS1 maint: uses authors parameter (link)
  9. Du MQ, Liu H, Diss TC, et al. (2001). "Kaposi sarcoma-associated herpesvirus infects monotypic (IgM lambda) but polyclonal naive B cells in Castleman disease and associated lymphoproliferative disorders". Blood. 97 (7): 2130–6. doi:10.1182/blood.v97.7.2130. PMID 11264181.
  10. Greer, JP; Arber DA; Glader B; et al. (2013). Wintrobe's Clinical Hematology (13th ed.). Lippincott Williams & Wilkins. ISBN 978-1-4511-7268-3.
  11. Oksenhendler E, Boulanger E, Galicier L, et al. (2002). "High incidence of Kaposi sarcoma-associated herpesvirus-related non-Hodgkin lymphoma in patients with HIV infection and multicentric Castleman disease". Blood. 99 (7): 2331–6. doi:10.1182/blood.v99.7.2331. PMID 11895764.
  12. Yamada M, Katano H, Yotsumoto M, et al. (2014). "Unique expression pattern of viral proteins in human herpesvirus 8-positive plasmablastic lymphoma: a case report". Int J Clin Exp Pathol. 7 (9): 6415–8. PMC 4203273. PMID 25337302.
  13. Carbone A, Gloghini A (2008). "KSHV/HHV8-associated lymphomas". Br. J. Haematol. 140 (1): 13–24. doi:10.1111/j.1365-2141.2007.06879.x. PMID 17991301.CS1 maint: uses authors parameter (link)
  14. Cesarman E, Knowles DM (1997). "Kaposi's sarcoma-associated herpesvirus: a lymphotropic human herpesvirus associated with Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman's disease". Semin Diagn Pathol. 14 (1): 54–66. PMID 9044510.CS1 maint: uses authors parameter (link)
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